title: Skin vasomotor reflex predicts circulatory responses to laryngoscopy and intubation.
abstract: BACKGROUND
  An evaluation of autonomic reactivity may help to predict circulatory responses to intubation. The relation between the magnitude of the skin vasomotor reflex (SVmR) immediately before laryngoscopy and the circulatory responses to intubation was examined.
  
  
  METHODS
  Forty-four adult patients (classified as American Society of Anesthesiologists physical status I or II) were studied. General anesthesia was induced with fentanyl and thiamylal and maintained with nitrous oxide and sevoflurane. The SVmR was evoked by an electrostimulus to the ulnar nerve, and decreases in skin blood flow were detected using a laser-Doppler flowmeter. In study 1, two groups of patients were studied. In the monitored group (n = 14), laryngoscopy was performed when the SVmR amplitude had decreased to less than 0.1. In the control group (n = 15), intubation was performed regardless of changes in the SVmR amplitude. In study 2, after induction, the end-tidal concentration of sevoflurane was maintained at 1 MAC (n = 9) or 1.3 MAC (n = 6) for 5 min. The SVmR was tested by changing the electric intensity.
  
  
  RESULTS
  In study 1, the blood pressure and heart rate of the control group increased significantly (P < 0.01) after laryngoscopy. The blood pressure of the monitored group did not increase. The SVmR amplitude and the systolic blood pressure changes showed a significant linear correlation (P < 0.001). In study 2, the relation between the electric intensity and the SVmR amplitude showed a weak but significant correlation (P < 0.01) in the 1 MAC group.
  
  
  CONCLUSIONS
  The evaluation of the SVmR provides useful information for determining the optimal anesthetic depth for laryngoscopy and intubation in individual patients.
authors.affiliation: Department of Anesthesiology, Kumamoto University School of Medicine, Honjo, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Shimoda
authors.forename: Y
authors.initials: Y
authors.lastname: Ikuta
authors.forename: M
authors.initials: M
authors.lastname: Sakamoto
authors.forename: H
authors.initials: H
authors.lastname: Terasaki
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D004558:Electric Stimulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D017078:Laser-Doppler Flowmetry; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D011237:Predictive Value of Tests; D012018:Reflex; D000077149:Sevoflurane; D012867:Skin / Q000098:blood supply* / Q000294:innervation; D014459:Ulnar Nerve; D014666:Vasomotor System
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane